Antianxiety Medications

• Side effects:
• drowsiness, slurred speech, headache, mental confusion, disorientation, nystagmus, ataxia, agitation, sleep disturbances (changes in REM sleep), hangover, oversedation

• Think alcohol, and don't use it. 
• Most if not all can be habit forming.
• Many sleep aids are benzo derivatives. 
• Can cause cleft lip/pallet to fetus during 1st trimester. 
• Cx for elderly with sundowners. May-->psychotic episodes. 

Increases GABA released-->v cranial activity --> calmness.

• Monitor for oversedation side effects: slurred speech, sleeping, drowsiness.
• Teach clients not to use alcohol which can potentiate the effects of valium. 
• Increased risk for congenital anomalies in the 1st trimester.  Use with caution in women who become pregnant or who are pregnant.
• It is excreted in breast milk and should be used with caution in nursing mothers. 
• Do not take with MAO inhibitors
• Antacids may delay the absorption.
• Used with caution in the elderly.  Lower doses (one half to one third) should be
•  considered.
• Slow IV administration of benzodiazepines. Valium/diazepam = 1 mg./minute.
• For IM administration, give deeply in muscle to eliminate irritation.
• PRN administration is preferable to regularly scheduled doses because of the tendency for addiction to occur. Even a 6 month course of taking Xanax/alprazolam can cause difficulty when trying to get patients off. The agitation and anxiety prevent some from wanting to quit taking the medication.
• Tapering is a safe way to discontinue because of risk for seizures.

• Side Effects: Drowsiness
• Use: Short-term management of anxiety and sleep
• Action: Depresses subcortical centers. Has no dependence, tolerance or intoxication. Can be used for indefinite periods and with patients who abuse substances.
• Nursing implications: Give Vistaril deep IM using Z-track method

• Side effects:  Headache, blurred vision, numbness, dizziness, excitement, feeling angry, nervousness, hostile behavior, nausea, and/or CHF.
• Uses: Generalized anxiety disorders, can be used to treat anxiety in medically compromised clients such as those who have asthma or COPD.
• Action:  Stimulates serotonin release from sending cells to synaptic clefts.

• Alleviates anxiety and does not appear to have an addition potential.
• Requires 2 weeks to reach a therapeutic blood level. Teach clients to continue taking it and they may not feel better as soon.
• Cannot eat grapefruit or drink grapefruit juice when taking buspirone.

• Side effects: Decreased sexual ability, drowsiness, difficulty sleeping, weakness, unusual tiredness.
• Action: Blocks peripheral and central norepinephrine activity which blocks the fight or flight response.
• Indications: Blood pressure must be high enough to take it.
• Uses: Anxiety, GAD, PTSD, stage flight, migraine headaches

• Fluvoxamine (Luvox) SSRI (blocks the reuptake of serotonin) 
• Side effects: Nausea, nervousness, drowsiness, insomnia, worsening of seizures

Mechanism of Action:  Its precise mechanism of action is unknown for OCD, but its ability to block the reuptake of serotonin (5-HT) is believed to be important.

Anticholenergic effects = "No see, no pee, no spit, no shit."